HomeMy WebLinkAboutListing of claims activity Agnt CLARK GENERAL INSURANCE
1505 ALLISON LANE
P.O. BOX 847
JEFFERSONVILLE, IN 47131-0847
PHONE (812)282-7797 FAX (812)282-3172
JUNE WILSON~ AGENT
09/08/03
Enclosed please fred loss runs for dates: 2001 to June, 2003.
Please place with the current Arch Property & Casualty Insurance Policy.
Thank you,
June Wilson
CLARK GENERAL INSURANCE
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ARCH INSURANCE COMPANY
ENDORSEMENTNO. 44
ATTACHED TO
AND FORMING ENDORSEMENT EFFECTIVE AGENCY
A PART OF (Standard time) INSURED AND
POLICY NUMBER MO DAY YR 12:01 NOON CODE
AM
KMPKG00383 7/6/2004 X City of Jeffersonville , KC001
THIS ENDORSEMENT CHANGES T, HE POLICY. PLEASE READ IT CAREFULLY
In consideration for the premium charged it is hereby understood and agreed the following change(s) have been
made to the AUTOMOBILE section(s) of this policy:
ADD 1993 International Dump Truck 4686
I Type I Value IC°mp
Ded I Coil
Ded I
7 $ 30,000 $ 250 $ 500
PREMIUM DUE: $
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED
AUTHORIZED REPRESENTATIVE
AGENT: 398 Clark General
DATE: 7/27/2004
ENTRY PERSON D. Cheek
AIMUIL0015 3 3003 original
JUL 2 ? 200 1
DATE
ARCHINSURANCECOMPANY
/
ENDORSEMENT NO. 45
ATTACHED TO
AND FORMING ENDORSEMENT EFFECTIVE AGENCY
A PART OF (Standard time) INSURED AND CODE
POLICY NUMBER MO DAY YR 12:01 NOON
AM
KMPKG00383 7/23/2004 X City of Jeffersonville KC001
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
In cOnsideration for the premium charged it is hereby understood and agreed the following change(s) have been
made to the PROPERTY section(s) of this policy:
CHANGE FROM 16 $ 20,000 1005 FuitonFfrk Park Bldg 1 R 1960 400
CHANGE TO 16 $ 20,000 $ 5,000 1005 Fuiton/Trk Park Bldg 1 R 1960 400
CHANGE FROM 16 $ 30,000 Mechanics/Const Crew Bldg 1 R 1960 400
CHANGETO 16 $ 30,000 $ 15,000 Mechanics/ConstCrewBIdg 1 R 1960 400
PREMIUM DUE: $ - WAIVED
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED
AUTHORIZED REPRESENTATIVE
JUL 2 ? 200
DATE
AGENT:
DATE:
ENTRY PERSON
AIMUIL0015 3 2003
398 Clark General
7/27/2004
D. Cheek
Original
ARCHINSURANCE COMPANY
ENDORSEMENT NO. 43
ATTACHED TO
AND FORMING ENDORSEMENT EFFECTIVE AGENCY
A PART OF (Standard time) INSURED AND CODE
POLICY NUMBER MO DAY YR 12:01 NOON
AM
KMPKG00383 7/1/2004 X City of Jeffersonville KC001
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
In consideration for the premium charged it is hereby understood and agreed the following change(s)
have been made to the INLAND MARINE section(s) of this policy
' Item tM
Status Year Make Model Serial # Limit Valuation Deductible
ADD Gas Pumps with Tanks Above Ground $ 10,000 R $ 500
PREMIUM DUE: $ - WAIVED
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED
AUTHORIZED REPRESENTATIVE DATE
AGENT: 398 Clark General
DATE: 7/27/2004
ENTRY PERSON D. Cheek
AIMUIL0015 3 2003
Original